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An LVAD helps maintain the pumping capacity of a heart that is too weak to function on its own
A left ventricular assist device (LVAD) is a surgically implanted mechanical device that pumps blood from the lower left chamber of the heart (ventricle) to the rest of the body. An LVAD helps maintain the pumping capacity of a heart that is too weak to function on its own.
In the case of severe heart failure, LVADs can improve survival rates and quality of life.
What are the different parts of an LVAD?
There are several types of LVADs available, all of which are portable and made up of four major components:
- Heart pump: Connected to the left side of the heart and transports blood from the heart to the rest of the body
- Batteries: Supply power to the LVAD to keep it functioning
- Driveline: Power and data are sent between the controller and the cardiac pump through this cable
- Controller: Powers s the pump and driveline and provides alerts on how the system is working
An LVAD is joined to the apex or tip of the left ventricle on one end and the aorta (major artery) on the other. The heart pumps blood into the LVAD, which constantly pumps blood to the rest of the body.
When do patients need an LVAD?
The left ventricle delivers oxygenated blood to tissues throughout the body to maintain healthy blood circulation.
An LVAD is typically used for patients who have significantly weakened hearts despite drug therapy, especially in cases of advanced congestive heart failure. In heart failure, the heart muscle weakens and loses its capacity to pump enough blood to maintain body functions. End-stage congestive heart failure patients may experience the following symptoms:
- Persistent low blood pressure
- Breathlessness
- Swelling
- Lethargy
- Difficulty sleeping, eating, walking
- Disrupted organ functions, such as the kidney and liver
An LVAD improves organ function and relieves symptoms of congestive heart failure by increasing blood flow to the body. As a result, patients can expect a longer life expectancy and a higher quality of life, as well as more energy.
The main reasons why a patient may need an LVAD include the following:
- Temporary therapy: If a patient is on the waiting list for a donor heart, they may require a temporary LVAD before receiving a heart transplant. When the patient receives a new heart, the LVAD is no longer needed and is removed.
- Permanent therapy: Other individuals with end-stage heart failure who are not candidates for a heart transplant may be eligible to have an LVAD implanted permanently for the rest of their lives (referred to as “destination treatment”).
- Temporary or permanent therapy: Sometimes patients are too ill to be eligible for a heart transplant. However, if they become stronger, they may become eligible. In some cases, an LVAD can be installed to test whether it can help a patient get strong enough to be considered for a heart transplant (referred to as “bridge to candidacy”).
A left ventricular assist device implantation allows the heart to rest and recuperate, eventually allowing the heart to operate normally. In some cases, a left ventricular assist device can be placed as a long-term option.
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In the U.S., 1 in every 4 deaths is caused by heart disease.
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What to expect with LVAD implantation
If you are a candidate for a left ventricular assist device (LVAD), your doctor will most likely order several tests to verify your compatibility before the implant:
- Diagnostic testing, such as an echocardiogram or cardiac catheterization
- General health screening, which includes blood tests and chest X-rays
Because implanting an LVAD requires open-heart surgery, you may need to be hospitalized for a few days before the procedure.
During the procedure
- The surgery takes between 4-8 hours.
- During the surgery, you will be sedated and linked to a ventilator and heart-lung bypass machine, which will temporarily take over your lung and heart functions.
- The surgeon will create an incision in your chest and access the breastbone (sternum) to install the LVAD.
- The LVAD pump is implanted directly into the tip (apex) of the left ventricle of the heart and will carry blood via the tube to the aorta, where it will be circulated throughout the body.
- Outside the body, a cable links the pump to a control device and battery pack.
- Once the LVAD has been appropriately implanted and evaluated, you will be disconnected from the heart-lung bypass machine and the LVAD will take over, pumping blood from the heart to the aorta.
After the procedure
- Following the surgery, you will be admitted to the intensive care unit (ICU) for a few days, where you will be given intravenous fluids, nutrients, and medicines, while other tubes drain urine from your bladder and fluids from your chest and heart.
- You may need to use a ventilator until your lungs can work properly.
- Recovery time varies depending on your condition. You may need to stay in the hospital for at least 2 weeks after being discharged from the ICU.
Living with an LVAD
- Patients who have an LVAD should avoid swimming, sleeping on the stomach, and getting a magnetic resonance scan.
- You should be able to resume your usual activities if you carefully follow your doctor's recommendations.
- You will be encouraged to live a healthy lifestyle, and your health will be regularly monitored to ensure that you are adjusting well to life with the LVAD.
What are the risks and complications of an LVAD implantation?
Possible risks and complications of LVAD implantation include:
- Infection
- Bleeding or blood clots
- Stroke
- Right heart failure
- Device malfunction, such as power failure or faulty parts that could cause the LVAD to stop working (rare)
